I’ve been profoundly changed by reading this book. It’s about Gawande’s growth as a physician. It’s a history lesson on medicine and public health. It’s actually all about the death of his father. It’s a demand for nursing home reform. It’s an exploration of pain management, fear, privacy, fighting for your life, and trying to calculate the incalculable timeline of our lives. And it’s about the complexity of dying happy, how to play by the shifting rules of “peak end” experience.
Below I’ve got twelve quotes from the book for you to consider and some important questions from the book that are worth t h i n k i n g about.
Must read chapters
Chapters 3 &4 Dependence and Assistance
...the advances of modern medicine have given us two revolutions: we’ve undergone a biological transformation of the course of our lives and also a cultural transformation of how we think about that course.
...Who clamors for geriatricians?...... When the prevailing fantasy is that we can be ageless, the geriatrician’s uncomfortable demand is that we accept we are not. p.46
It is not death that the very old tell me they fear. It is what happens short of death- losing their hearing, their memory, their best friends, their way of life. p.55
How did we wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over our lives?....turns out it is a medical story…… We didn’t look around and say to ourselves, “you know, there’s this phase of people’s lives in which they can’t really cope on their own, and we ought to find a way to make it manageable.” No, instead we said, “this looks like a medical problem. Let’s put these people in the hospital”.
The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul.
I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created anew difficulty for mankind: how to die.
Hope is not a plan but hope is our plan.
We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You want someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.
ODTAA syndrome: the syndrome of One Damn Thing After Another. It does not have a totally predictable path. The pauses between crises can vary. But after a certain point, the direction of travel becomes clear.
At least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality- the courage to seek out the truth of what is to be feared and what is to be hoped. Such courage is difficult enough. We have many reasons to shrink from it. But even more daunting is the second kind of courage-the courage to act on the truth we find. The problem is that the wise course is so frequently unclear. For a long while, I thought that this was simply because of uncertainty. When it is hard to know what will happen, it is hard to know what to do. But the challenge, I’ve come to see, is more fundamental than that. One has to decide whether one’s fears or one’s hopes are what should matter most.
Peak-End rule. People seemed to have two different selves-an experiencing self who endures every moment equally and a remembering self who gives almost all the wight of judgment afterward to two single points in time, the worst moment and the last one.
….. If the remembering self and the experiencing self can come to radically different opinions about the same experience, then the difficult question is which one to listen to.
Technological society has forgotten what scholars call the “dying role” and its importance to people as life approaches its end. People want to share memories, pass on wisdom and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among life’s most important, for both the dying and those left behind. And if it is, the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame.
If independence is what we live for, what do we do when it can no longer be sustained?
What abilities matter most in your life?
How will we make life worth living when we’re weak and frail and can’t fend for ourselves anymore?
What is important to you? What are your worries?